3.50.6 StructureDefinition: Shared Health Patient - Detailed Descriptions
Definitions for the profile-patient Profile.
1. Patient | |
Definition | Demographics and other administrative information about an individual or animal receiving care or other health-related services. |
Control | 0..* |
Must Support | true |
Alternate Names | SubjectOfCare Client Resident |
Comments | Patient will contain two identifiers. One will represent the creator's local identifier and the second will be the jurisdication health number. |
Max Length | 0 |
2. Patient.id | |
Definition | The logical id of the resource, as used in the URL for the resource. |
Control | 1..1 |
Type | id |
Must Support | true |
Comments | Conformance Rule: Must be a GUID that is assigned by the sending application. |
Max Length | 0 |
3. Patient.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. |
Control | 0..1 |
Type | Meta |
Max Length | 0 |
4. Patient.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. |
Control | 0..1 |
Type | uri |
Is Modifier | true |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible. |
Max Length | 0 |
5. Patient.language | |
Definition | The base language in which the resource is written. |
Control | 0..1 |
Binding | The codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language. |
Type | code |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Max Length | 0 |
6. Patient.text | |
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Control | 0..1 This element is affected by the following invariants: dom-1 |
Type | Narrative |
Alternate Names | narrative, html, xhtml, display |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. |
Max Length | 0 |
7. Patient.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. |
Control | 0..* |
Type | Resource |
Alternate Names | inline resources, anonymous resources, contained resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. |
Max Length | 0 |
8. Patient.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
9. Patient.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
10. Patient.identifier | |
Definition | The identifier for the patient as known to the sending application. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..2 |
Type | Identifier |
Must Support | true |
Requirements | Allows a patient to be referred to unambiguously. Because this is the principal mechanism for identifying humans, the attribute is mandatory. If an identifier is not known, it should be looked up using the 'client registry' capabilities of the EHR application. Allows the EMR to automate patient selection. Allows for easy linking. |
Max Length | 0 |
Slicing | This element introduces a set of slices on Patient.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
11. Patient.identifier:senderPatientIdentifier | |
SliceName | senderPatientIdentifier |
Definition | A technical identifier - identifies some entity uniquely and unambiguously. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..1 |
Type | Identifier(Shared Health Person Identifier) |
Must Support | true |
Requirements | Patients are almost always assigned specific numerical identifiers. |
Comments | Conformance Rule: Patient.identifier(senderPatientIdentifier) MAY be stored by the receiving application and used for linking Conformance Rule: This must follow the OID format: [Vendor].[ApplicationInstance].1. The branch, “.1” is appended to create a unique namespace for the Patient Identifer Conformance Rule: Location EMR/PMS Patient ID: EMR's and PMS MUST include the local patient ID in the message. This will require an identifier system issued by the EMR and PMS by Application Instance ID. Usage Note: This MUST be stored by PMS/EMR and echoed back in subsequent messages (e.g. eRAR, discontinue, refuse to fill) that relate to this patient. This is intended to provide assistance in automation for PMS/EMR who receive this information, however each vendor can determine the level of automation that is appropriate for them. If an EMR chooses to use the PMS Patient ID (or conversely, the PMS uses the EMR ID) for automatic linking, they should also validate using other demographic data provided in the message as a precaution. When prescribing narcotics and controlled substances in Ontario, only the Jurisdictional Health Card number (of those allowed by Ontario regulation) can be conveyed as part of the Patient Resource. If a prescriber wishes to include another type of identification, this can be conveyed using the Prescriber Instructions. In future, the full set of identifier types will be supported within the messaging standard. |
Max Length | 0 |
12. Patient.identifier:senderPatientIdentifier.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
13. Patient.identifier:senderPatientIdentifier.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
14. Patient.identifier:senderPatientIdentifier.use | |
Definition | The purpose of this identifier. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Max Length | 0 |
15. Patient.identifier:senderPatientIdentifier.type | |
Definition | A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. |
Control | 1..1 |
Binding | The codes SHALL be taken from SharedIdentifierType (20190415); other codes may be used where these codes are not suitable |
Type | CodeableConcept(Shared Health CodeableConcept Code) |
Must Support | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Comments | See children for fixed values. |
Max Length | 0 |
16. Patient.identifier:senderPatientIdentifier.type.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
17. Patient.identifier:senderPatientIdentifier.type.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
18. Patient.identifier:senderPatientIdentifier.type.coding | |
Definition | A reference to a code defined by a terminology system. |
Control | 1..1 |
Type | Coding |
Must Support | true |
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. |
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true. |
Max Length | 0 |
19. Patient.identifier:senderPatientIdentifier.type.coding.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
20. Patient.identifier:senderPatientIdentifier.type.coding.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
21. Patient.identifier:senderPatientIdentifier.type.coding.system | |
Definition | The identification of the code system that defines the meaning of the symbol in the code. |
Control | 1..1 |
Type | uri |
Must Support | true |
Requirements | Need to be unambiguous about the source of the definition of the symbol. |
Comments | Fixed value: http://hl7.org/fhir/v2/0203 |
Max Length | 0 |
Fixed Value | http://hl7.org/fhir/v2/0203 |
22. Patient.identifier:senderPatientIdentifier.type.coding.version | |
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. |
Note | This is a business versionId, not a resource version id (see discussion) |
Control | 0..1 |
Type | string |
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. |
Max Length | 0 |
23. Patient.identifier:senderPatientIdentifier.type.coding.code | |
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). |
Control | 1..1 |
Type | code |
Must Support | true |
Requirements | Need to refer to a particular code in the system. |
Comments | Fixed value: MR |
Max Length | 0 |
Fixed Value | MR |
24. Patient.identifier:senderPatientIdentifier.type.coding.display | |
Definition | A representation of the meaning of the code in the system, following the rules of the system. |
Control | 0..1 |
Type | string |
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. |
Max Length | 0 |
25. Patient.identifier:senderPatientIdentifier.type.coding.userSelected | |
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). |
Control | 0..1 |
Type | boolean |
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. |
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. |
Max Length | 0 |
26. Patient.identifier:senderPatientIdentifier.type.text | |
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. |
Control | 0..1 |
Type | string |
Must Support | true |
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. |
Comments | Very often the text is the same as a displayName of one of the codings. |
Max Length | 0 |
27. Patient.identifier:senderPatientIdentifier.system | |
Definition | Establishes the namespace in which set of possible id values is unique. |
Control | 1..1 |
Type | uri |
Must Support | true |
Requirements | There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers. |
Comments | Conformance Rule: This must be an OID of the form [Vendor OID].[Application Instance node].1 expressed as a uri (e.g. urn:oid:1.2.3.4). A branch, “.1” is appended to create a unique namespace for the Patient ID. |
Max Length | 0 |
Example | General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri |
Invariants | Defined on this element senderPatientIdentifier-branch-1: This must be an OID ending in .1 (: $this.matches('^urn\\:oid\\:(\\d+\\.)+1$')) |
28. Patient.identifier:senderPatientIdentifier.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Control | 1..1 |
Type | string |
Must Support | true |
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. |
Max Length | 0 |
Example | General:123456 ???:123456 |
29. Patient.identifier:senderPatientIdentifier.period | |
Definition | Time period during which identifier is/was valid for use. |
Control | 0..1 |
Type | Period |
Max Length | 0 |
30. Patient.identifier:senderPatientIdentifier.assigner | |
Definition | Organization that issued/manages the identifier. |
Control | 0..1 |
Type | Reference(Organization) |
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. |
Max Length | 0 |
31. Patient.identifier:jurisdictionalHealthNumber | |
SliceName | jurisdictionalHealthNumber |
Definition | A technical identifier - identifies some entity uniquely and unambiguously. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier(Shared Health Person Identifier) |
Must Support | true |
Requirements | Patients are almost always assigned specific numerical identifiers. |
Comments | Conformance Rule: This will be the OID representing the jurisdictional health number. Usage Note: If both a federal and provincial health number are available, provide the provincial health number. |
Max Length | 0 |
32. Patient.identifier:jurisdictionalHealthNumber.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
33. Patient.identifier:jurisdictionalHealthNumber.extension | |
Definition | An Extension |
Control | 0..* |
Type | Extension |
Must Support | true |
Max Length | 0 |
Slicing | This element introduces a set of slices on Patient.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
34. Patient.identifier:jurisdictionalHealthNumber.extension:phn-version | |
SliceName | phn-version |
Definition | Indicates the version number associated with a provincial health numner |
Control | 0..1 |
Type | Extension(Patient PHN version) (Extension Type: string) |
Must Support | true |
Max Length | 0 |
35. Patient.identifier:jurisdictionalHealthNumber.use | |
Definition | The purpose of this identifier. |
Control | 0..1 |
Binding | The codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known . |
Type | code |
Is Modifier | true |
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. |
Comments | This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. |
Max Length | 0 |
36. Patient.identifier:jurisdictionalHealthNumber.type | |
Definition | A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. |
Control | 1..1 |
Binding | The codes SHALL be taken from SharedIdentifierType (20190415); other codes may be used where these codes are not suitable |
Type | CodeableConcept(Shared Health CodeableConcept Code) |
Must Support | true |
Requirements | Allows users to make use of identifiers when the identifier system is not known. |
Comments | - |
Max Length | 0 |
37. Patient.identifier:jurisdictionalHealthNumber.type.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
38. Patient.identifier:jurisdictionalHealthNumber.type.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
39. Patient.identifier:jurisdictionalHealthNumber.type.coding | |
Definition | A reference to a code defined by a terminology system. |
Control | 1..1 |
Type | Coding |
Must Support | true |
Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. |
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true. |
Max Length | 0 |
40. Patient.identifier:jurisdictionalHealthNumber.type.coding.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
41. Patient.identifier:jurisdictionalHealthNumber.type.coding.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
42. Patient.identifier:jurisdictionalHealthNumber.type.coding.system | |
Definition | The identification of the code system that defines the meaning of the symbol in the code. |
Control | 1..1 |
Type | uri |
Must Support | true |
Requirements | Need to be unambiguous about the source of the definition of the symbol. |
Comments | Fixed value: http://hl7.org/fhir/v2/0203 |
Max Length | 0 |
Fixed Value | http://hl7.org/fhir/v2/0203 |
43. Patient.identifier:jurisdictionalHealthNumber.type.coding.version | |
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. |
Note | This is a business versionId, not a resource version id (see discussion) |
Control | 0..1 |
Type | string |
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. |
Max Length | 0 |
44. Patient.identifier:jurisdictionalHealthNumber.type.coding.code | |
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). |
Control | 1..1 |
Type | code |
Must Support | true |
Requirements | Need to refer to a particular code in the system. |
Comments | Fixed value: JHN |
Max Length | 0 |
Fixed Value | JHN |
45. Patient.identifier:jurisdictionalHealthNumber.type.coding.display | |
Definition | A representation of the meaning of the code in the system, following the rules of the system. |
Control | 0..1 |
Type | string |
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. |
Max Length | 0 |
46. Patient.identifier:jurisdictionalHealthNumber.type.coding.userSelected | |
Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). |
Control | 0..1 |
Type | boolean |
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. |
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. |
Max Length | 0 |
47. Patient.identifier:jurisdictionalHealthNumber.type.text | |
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. |
Control | 0..1 |
Type | string |
Must Support | true |
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. |
Comments | Very often the text is the same as a displayName of one of the codings. |
Max Length | 0 |
48. Patient.identifier:jurisdictionalHealthNumber.system | |
Definition | Establishes the namespace in which set of possible id values is unique. |
Control | 1..1 |
Binding | The codes SHALL be taken from SharedPatientJurisdictionalHealthIdentifierType |
Type | uri |
Must Support | true |
Requirements | There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers. |
Max Length | 0 |
Example | General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri |
49. Patient.identifier:jurisdictionalHealthNumber.value | |
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system. |
Control | 1..1 |
Type | string |
Must Support | true |
Comments | Conformance Rule: This is the human readable Patient Identifier from the sending system |
Max Length | 0 |
Example | General:123456 ???:123456 |
50. Patient.identifier:jurisdictionalHealthNumber.period | |
Definition | Time period during which identifier is/was valid for use. |
Control | 0..1 |
Type | Period |
Max Length | 0 |
51. Patient.identifier:jurisdictionalHealthNumber.assigner | |
Definition | Organization that issued/manages the identifier. |
Control | 0..1 |
Type | Reference(Organization) |
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. |
Max Length | 0 |
52. Patient.active | |
Definition | Whether this patient record is in active use. |
Control | 0..1 |
Type | boolean |
Is Modifier | true |
Requirements | Need to be able to mark a patient record as not to be used because it was created in error. |
Comments | Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient. |
Max Length | 0 |
Default Value | true |
53. Patient.name | |
Definition | A human's name with the ability to identify parts and usage. |
Control | 1..3 |
Type | HumanName(Shared Health HumanName) |
Must Support | true |
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name. |
Comments | Conformance Rule: There are explicit conformance rules defined in Shared Health HumanName profile. |
Max Length | 0 |
Slicing | This element introduces a set of slices on Patient.name. The slices are unordered and Open, and can be differentiated using the following discriminators:
|
54. Patient.name:legalName | |
SliceName | legalName |
Definition | A human's name with the ability to identify parts and usage. |
Control | 1..1 |
Type | HumanName(Shared Health HumanName) |
Must Support | true |
Requirements | Need to be able to track the patient by multiple names. Examples are your official name and a partner name. |
Comments | This data type is used to support both Practitioner names and Patient names. These name values are used for SAML validation (Practitioner) and eFax generation, and possibly patient matching algorithms. Conformance Rule: For the purpose of presentation, the data elements will be organized as Prefix + Given1 + Given2 + Family + Suffix. |
Max Length | 0 |
55. Patient.name:legalName.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
56. Patient.name:legalName.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
57. Patient.name:legalName.use | |
Definition | Identifies the purpose for this name. |
Control | 1..1 |
Binding | The codes SHALL be taken from SharedNameUse (20190415) |
Type | code |
Is Modifier | true |
Must Support | true |
Requirements | Allows the appropriate name for a particular context of use to be selected from among a set of names. |
Comments | Fixed value: official |
Max Length | 0 |
Fixed Value | official |
58. Patient.name:legalName.text | |
Definition | A full text representation of the name. |
Control | 0..1 |
Type | string |
Requirements | A renderable, unencoded form. |
Comments | Can provide both a text representation and structured parts. |
Max Length | 0 |
59. Patient.name:legalName.family | |
Definition | The part of a name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father. |
Control | 1..1 |
Type | string |
Must Support | true |
Alternate Names | surname |
Comments | Conformance rule: Family is not to include professional designations |
Max Length | 0 |
60. Patient.name:legalName.given | |
Definition | Given name. |
Control | 1..2 |
Type | string |
Must Support | true |
Alternate Names | first name, middle name |
Comments | Conformance Rule: Given name(s) is not to include profession designations |
Max Length | 0 |
61. Patient.name:legalName.prefix | |
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the start of the name. |
Control | 0..1 |
Type | string |
Must Support | true |
Comments | Conformance Rule: Prefix or Suffix must be used for Practitioner to represent the appropriate professional designation. |
Max Length | 0 |
62. Patient.name:legalName.suffix | |
Definition | Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name. |
Control | 0..1 |
Type | string |
Must Support | true |
Comments | Conformance Rule: Prefix or Suffix must be used for Practitioner to represent the appropriate professional designation. |
Max Length | 0 |
63. Patient.name:legalName.period | |
Definition | Indicates the period of time when this name was valid for the named person. |
Control | 0..1 |
Type | Period |
Requirements | Allows names to be placed in historical context. |
Max Length | 0 |
64. Patient.telecom | |
Definition | Details for all kinds of technology mediated contact points for a person or organization, including telephone, email, etc. |
Control | 0..* |
Type | ContactPoint(Shared Health ContactPoint) |
Must Support | true |
Requirements | Can be used to record a temporary contact mechanism (phone, email) for the purposes of this action.Not intended for use to confirm patient identity. Important for following up with patient but not always available. |
Comments | Conformance Rule: There are explicit conformance rules defined to format the value. Please refer to Shared Health ContactPoint profile for these details. Conformance Rule: Only a value of 'phone' is supported for PrescribeIT®. The inclusion of email or fax information is prohibited. |
Max Length | 0 |
Invariants | Defined on this element cpt-2: A system is required if a value is provided. (: value.empty() or system.exists()) |
65. Patient.gender | |
Definition | Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes. |
Control | 1..1 |
Binding | The codes SHALL be taken from Gender (20190415) |
Type | code |
Must Support | true |
Requirements | Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes. |
Comments | Conformance Rule: Vendors must support a minimum set of codes. The gender may not match the biological sex as determined by genetics, or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a hard error. |
Max Length | 0 |
66. Patient.birthDate | |
Definition | The date of birth for the individual. |
Control | 1..1 |
Type | date |
Must Support | true |
Requirements | Age of the individual drives many clinical processes. |
Comments | Usage Note: It is expected that the real date of birth is known by the prescriber and pharmacy and that the full date of birth must be submitted. |
Max Length | 0 |
LOINC Code | 21112-8 |
67. Patient.deceased[x] | |
Definition | Indicates if the individual is deceased or not. |
Control | 0..1 |
Type | Choice of: boolean, dateTime |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Is Modifier | true |
Requirements | The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive. |
Comments | If there's no value in the instance it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive. |
Max Length | 0 |
68. Patient.address | |
Definition | An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations and which might not be valid for mail delivery. There are a variety of postal address formats defined around the world. |
Control | 0..1 |
Type | Address(Shared Health Address) |
Must Support | true |
Requirements | May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification. |
Comments | Conformance Rule: There are explicit conformance rules defined to structure the address values. Please refer to Shared Health Address profile for these details. Conformance Rule: Patient address is optional, however, if it is available in the EMR, it MUST be provided, as complete as possible. Patient address will appear on the eFax. |
Max Length | 0 |
69. Patient.maritalStatus | |
Definition | This field contains a patient's most recent marital (civil) status. |
Control | 0..1 |
Binding | The codes SHALL be taken from Marital Status Codes The domestic partnership status of a person. |
Type | CodeableConcept |
Requirements | Most, if not all systems capture it. |
Max Length | 0 |
70. Patient.multipleBirth[x] | |
Definition | Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer). |
Control | 0..1 |
Type | Choice of: boolean, integer |
[x] Note | See Choice of Data Types for further information about how to use [x] |
Requirements | For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs. |
Comments | Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in tripplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this tripplets examle, then all 3 patient records would have valueBool=true (the ordering is not indicated). |
Max Length | 0 |
71. Patient.photo | |
Definition | Image of the patient. |
Control | 0..* |
Type | Attachment |
Requirements | Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too. |
Max Length | 0 |
72. Patient.contact | |
Definition | A contact party (e.g. guardian, partner, friend) for the patient. |
Control | 0..* |
Type | BackboneElement |
Requirements | Need to track people you can contact about the patient. |
Comments | Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact. |
Max Length | 0 |
Invariants | Defined on this element pat-1: SHALL at least contain a contact's details or a reference to an organization (: name.exists() or telecom.exists() or address.exists() or organization.exists()) |
73. Patient.contact.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
74. Patient.contact.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
75. Patient.contact.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
76. Patient.contact.relationship | |
Definition | The nature of the relationship between the patient and the contact person. |
Control | 0..* |
Binding | The codes SHALL be taken from PatientContactRelationship; other codes may be used where these codes are not suitable The nature of the relationship between a patient and a contact person for that patient. |
Type | CodeableConcept |
Requirements | Used to determine which contact person is the most relevant to approach, depending on circumstances. |
Max Length | 0 |
77. Patient.contact.name | |
Definition | A name associated with the contact person. |
Control | 0..1 |
Type | HumanName |
Requirements | Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person. |
Max Length | 0 |
78. Patient.contact.telecom | |
Definition | A contact detail for the person, e.g. a telephone number or an email address. |
Control | 0..* |
Type | ContactPoint |
Requirements | People have (primary) ways to contact them in some way such as phone, email. |
Comments | Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification. |
Max Length | 0 |
79. Patient.contact.address | |
Definition | Address for the contact person. |
Control | 0..1 |
Type | Address |
Requirements | Need to keep track where the contact person can be contacted per postal mail or visited. |
Max Length | 0 |
80. Patient.contact.gender | |
Definition | Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes. |
Control | 0..1 |
Binding | The codes SHALL be taken from AdministrativeGender The gender of a person used for administrative purposes. |
Type | code |
Requirements | Needed to address the person correctly. |
Max Length | 0 |
81. Patient.contact.organization | |
Definition | Organization on behalf of which the contact is acting or for which the contact is working. |
Control | 0..1 This element is affected by the following invariants: pat-1 |
Type | Reference(Organization) |
Requirements | For guardians or business related contacts, the organization is relevant. |
Max Length | 0 |
82. Patient.contact.period | |
Definition | The period during which this contact person or organization is valid to be contacted relating to this patient. |
Control | 0..1 |
Type | Period |
Max Length | 0 |
83. Patient.animal | |
Definition | This patient is known to be an animal. |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | true |
Requirements | Many clinical systems are extended to care for animal patients as well as human. |
Comments | The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records. The absense of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal). |
Max Length | 0 |
84. Patient.animal.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
85. Patient.animal.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
86. Patient.animal.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
87. Patient.animal.species | |
Definition | Identifies the high level taxonomic categorization of the kind of animal. |
Control | 1..1 |
Binding | For example codes, see AnimalSpecies The species of an animal. |
Type | CodeableConcept |
Requirements | Need to know what kind of animal. |
Comments | If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It may or may not be Linnaean taxonomy and may or may not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.). |
Max Length | 0 |
88. Patient.animal.breed | |
Definition | Identifies the detailed categorization of the kind of animal. |
Control | 0..1 |
Binding | For example codes, see AnimalBreeds The breed of an animal. |
Type | CodeableConcept |
Requirements | May need to know the specific kind within the species. |
Comments | Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type. |
Max Length | 0 |
89. Patient.animal.genderStatus | |
Definition | Indicates the current state of the animal's reproductive organs. |
Control | 0..1 |
Binding | For example codes, see GenderStatus The state of the animal's reproductive organs. |
Type | CodeableConcept |
Requirements | Gender status can affect housing and animal behavior. |
Max Length | 0 |
90. Patient.communication | |
Definition | Languages which may be used to communicate with the patient about his or her health. |
Control | 0..* |
Type | BackboneElement |
Requirements | If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest. |
Comments | If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required. |
Max Length | 0 |
91. Patient.communication.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
92. Patient.communication.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
93. Patient.communication.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
94. Patient.communication.language | |
Definition | The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English. |
Control | 1..1 |
Binding | The codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language. |
Type | CodeableConcept |
Requirements | Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect. |
Comments | The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type. |
Max Length | 0 |
95. Patient.communication.preferred | |
Definition | Indicates whether or not the patient prefers this language (over other languages he masters up a certain level). |
Control | 0..1 |
Type | boolean |
Requirements | People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method. |
Comments | This language is specifically identified for communicating healthcare information. |
Max Length | 0 |
96. Patient.careProvider | |
Definition | Patient's nominated care provider. |
Control | 0..* |
Type | Reference(Organization | Practitioner) |
Comments | This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. This is not to be used to record Care Teams, these should be recorded on either the CarePlan or EpisodeOfCare resources. |
Max Length | 0 |
97. Patient.managingOrganization | |
Definition | Organization that is the custodian of the patient record. |
Control | 0..1 |
Type | Reference(Organization) |
Requirements | Need to know who recognizes this patient record, manages and updates it. |
Comments | There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association). |
Max Length | 0 |
98. Patient.link | |
Definition | Link to another patient resource that concerns the same actual patient. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | true |
Requirements | There are multiple usecases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers. |
Comments | There is no assumption that linked patient records have mutual links. |
Max Length | 0 |
99. Patient.link.id | |
Definition | unique id for the element within a resource (for internal references). |
Control | 0..1 |
Type | id |
Max Length | 0 |
100. Patient.link.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Control | 0..* |
Type | Extension |
Alternate Names | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
101. Patient.link.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. |
Control | 0..* |
Type | Extension |
Is Modifier | true |
Alternate Names | extensions, user content, modifiers |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Max Length | 0 |
102. Patient.link.other | |
Definition | The other patient resource that the link refers to. |
Control | 1..1 |
Type | Reference(Patient) |
Is Modifier | true |
Max Length | 0 |
103. Patient.link.type | |
Definition | The type of link between this patient resource and another patient resource. |
Control | 1..1 |
Binding | The codes SHALL be taken from LinkType The type of link between this patient resource and another patient resource. |
Type | code |
Is Modifier | true |
Max Length | 0 |